Arab Journal of Urology (2012) 10, 301–306
Arab Journal of Urology (Official Journal of the Arab Association of Urology) www.sciencedirect.com
REVIEW
Intracorporeal laser lithotripsy Athanasios G. Papatsoris a b
a,b,*
, Andreas Skolarikos a, Noor Buchholz
b
University Department of Urology, Sismanoglio Hospital, Athens, Greece Department of Urology, Bart and The London NHS Trust, London, UK
Received 21 January 2012, Received in revised form 28 February 2012, Accepted 29 February 2012 Available online 26 March 2012
KEYWORDS Laser; Lithotripsy; Intracorporeal; Stones; Endourology; Holmium ABBREVIATIONS URS, ureteroscopy; Ho:YAG, holmium:yttrium–aluminium–garnet; PCNL, percutaneous nephrolithotomy; FREDDY, frequency-doubled double-pulse Nd:YAG; EPS, endoscope-protection system
Abstract Objectives: To review the current literature on intracorporeal laser lithotripsy. Methods: We searched PubMed for relevant reports up to January 2012, using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’. Results: We studied 125 relevant reports of studies with various levels of evidence. Efficient lithotripsy depends on the laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical). The most efficient laser for stones in all locations and of all mineral compositions is the holmium yttrium–aluminium–garnet laser (Ho:YAG). The frequency-doubled double-pulse Nd:YAG laser functions through the generation of a plasma bubble. New laser systems, such as the erbium:YAG and the thulium laser, are under evaluation. Laser protection systems have also been developed for the novel digital flexible ureteroscopes. Although complications are rare, a high relevant clinical suspicion is necessary. Conclusions: Laser lithotripsy technology is continuously developing, while the Ho:YAG laser remains the reference standard for intracorporeal lithotripsy. ª 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.
Introduction * Corresponding author. E-mail address: [email protected] (A.G. Papatsoris). Peer review under responsibility of Arab Association of Urology.
Production and hosting by Elsevier
During the last few decades the surgical treatment of urolithiasis has undergone tremendous advances as a result of improvements in technology [1,2]. Currently ureteroscopy (URS) is a precise, minimally invasive surgical intervention that can assess the entire collecting system to treat a stone using intracorporeal lithotripsy [1].
2090-598X ª 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.aju.2012.02.006
302
The implication of laser technology in the development of lithotripter fibres has revolutionised intracorporeal lithotripsy. We searched PubMed (up to January 2012), using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’. From the 125 relevant articles of various levels of evidence, we present the most interesting and upto-date findings. Laser lithotripsy variables The efficient fragmentation of stones of diverse compositions and with minimal collateral tissue damage is primarily contingent on laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical) [3]. The pulse duration governs the dominant mechanism in stone fragmentation, which is either photothermal or photoacoustic/photomechanical. Lasers with long pulse durations (i.e. >10 ls) induce a temperature rise in the laser-affected zone, with minimal acoustic waves [3]. Stone material is removed by means of vaporisation, melting, mechanical stress and/or chemical decomposition. Short-pulsed laser ablation (i.e.
Arab Journal of Urology (Official Journal of the Arab Association of Urology) www.sciencedirect.com
REVIEW
Intracorporeal laser lithotripsy Athanasios G. Papatsoris a b
a,b,*
, Andreas Skolarikos a, Noor Buchholz
b
University Department of Urology, Sismanoglio Hospital, Athens, Greece Department of Urology, Bart and The London NHS Trust, London, UK
Received 21 January 2012, Received in revised form 28 February 2012, Accepted 29 February 2012 Available online 26 March 2012
KEYWORDS Laser; Lithotripsy; Intracorporeal; Stones; Endourology; Holmium ABBREVIATIONS URS, ureteroscopy; Ho:YAG, holmium:yttrium–aluminium–garnet; PCNL, percutaneous nephrolithotomy; FREDDY, frequency-doubled double-pulse Nd:YAG; EPS, endoscope-protection system
Abstract Objectives: To review the current literature on intracorporeal laser lithotripsy. Methods: We searched PubMed for relevant reports up to January 2012, using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’. Results: We studied 125 relevant reports of studies with various levels of evidence. Efficient lithotripsy depends on the laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical). The most efficient laser for stones in all locations and of all mineral compositions is the holmium yttrium–aluminium–garnet laser (Ho:YAG). The frequency-doubled double-pulse Nd:YAG laser functions through the generation of a plasma bubble. New laser systems, such as the erbium:YAG and the thulium laser, are under evaluation. Laser protection systems have also been developed for the novel digital flexible ureteroscopes. Although complications are rare, a high relevant clinical suspicion is necessary. Conclusions: Laser lithotripsy technology is continuously developing, while the Ho:YAG laser remains the reference standard for intracorporeal lithotripsy. ª 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.
Introduction * Corresponding author. E-mail address: [email protected] (A.G. Papatsoris). Peer review under responsibility of Arab Association of Urology.
Production and hosting by Elsevier
During the last few decades the surgical treatment of urolithiasis has undergone tremendous advances as a result of improvements in technology [1,2]. Currently ureteroscopy (URS) is a precise, minimally invasive surgical intervention that can assess the entire collecting system to treat a stone using intracorporeal lithotripsy [1].
2090-598X ª 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.aju.2012.02.006
302
The implication of laser technology in the development of lithotripter fibres has revolutionised intracorporeal lithotripsy. We searched PubMed (up to January 2012), using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’. From the 125 relevant articles of various levels of evidence, we present the most interesting and upto-date findings. Laser lithotripsy variables The efficient fragmentation of stones of diverse compositions and with minimal collateral tissue damage is primarily contingent on laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical) [3]. The pulse duration governs the dominant mechanism in stone fragmentation, which is either photothermal or photoacoustic/photomechanical. Lasers with long pulse durations (i.e. >10 ls) induce a temperature rise in the laser-affected zone, with minimal acoustic waves [3]. Stone material is removed by means of vaporisation, melting, mechanical stress and/or chemical decomposition. Short-pulsed laser ablation (i.e.
